Organization Intake Form – Greater Golden Triangle Resource Guide

Section 1 - Submitter Contact

This is information about the person who is submitting the organization's info. Submitter Contact will not be shown to the public.

First Name(Required)

Last Name(Required)

Phone(Required)

Email(Required)

Relationship to Organization(Required)

Staff

Volunteer

Board Member

Other

Section 2 - Organization Identity

Organization Name(Required)

Best Public Contact Name

Is there a particular person people in need should reach out to? If so, enter their name here. If not, you can leave blank.

Contact Title/Role

Counties Served(Required)

Check all that apply

Lowndes

Oktibbeha

Clay

Noxubee

Service Categories(Required)

Select all that apply

Section 3 - Public Contact Information

Primary Phone(Required)

Secondary Phone

e.g. Crisis Line, After-Hours, Toll-Free, Office

Secondary Phone Label

This is how the secondary phone number will be identified to the public

Email(Required)

Organization's Website URL

Facebook URL

Instagram URL

Other Social Media

Physical/Service Address

If your organization has a physical location, enter it here. Used for the Get Directions link on your directory listing. Leave blank if you serve clients remotely or by phone.

Street Address Address Line 2 City State ZIP Code

Mailing Address

Only if different from physical address

Street Address Address Line 2 City State ZIP Code

Section 4 - Hours & Access

Days and Hours Open to the Public

e.g. Monday–Friday 8am–5pm. Include any program-specific variations.

Appointment or Walk-In?(Required)

Appointment only

Walk-in welcome

Both

Call for availability

Section 5 - About the Organization

Organization Description(Required)

2 to 5 sentences. Mission, who you serve, types of services provided. This is the primary text on your directory listing.

Geographic Communities Served(Required)

Beyond county — specific towns, school districts, service radius, etc.

Eligibility/Qualifications Required(Required)

Enter "No requirements" if none. e.g. income guidelines, age, insurance status, referral needed.

Cost/Fee Information(Required)

Any additional detail about cost, fees, or financial assistance available.

Free

Sliding scale

Insurance accepted

Fees apply

Cost Detail

Any additional detail about cost, fees, or financial assistance available.

How Quickly Is Service Fulfilled?(Required)

e.g. Same day, within 72 hours, by appointment within two weeks, waitlist currently open.

Section 6 - Community Involvement

Volunteer Opportunities Available?

Yes

Volunteer Detail

Describe roles, requirements, and how to sign up.

Accepting Donations?

Yes

Donation Detail

Monetary, in-kind, items needed, donate link, etc.

Section 7 - Spanish Language

This information helps us connect Spanish-speaking residents with the right resources.

Spanish Speaking Staff Available?

Yes

Spanish-Language Materials Available?

Yes

Spanish Language Contact Name

Only list if different than the organization's primary contact.

Spanish Language Contact Phone

Section 8 - Media & Documents

Logo or Photo(Required)

Please upload your organization's logo or a representative photo. Used on your directory listing and in print materials. Recommended 1200 pixes wide, 800 pixels tall. If you only have a low-resolution image, upload it anyway — we'll follow up if we need a better version.

Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 1 MB.

Additional Documents

Brochures, flyers, annual reports, program guides — anything that helps describe your organization.

Accepted file types: pdf, docx, Max. file size: 1 MB.

Anything Else You'd Like Us To Know?

Any additional context about your organization, services, or how we can best represent you in the directory.